Investigations and Further Management
Bloods on this occasion revealed high inflammatory markers and a
worsening acute kidney injury: C-reactive protein was 211mg/L, white
blood cells 30.3x109/L, creatinine 298µmol/L, and
potassium 6.1mmol/L. The patient was initially medically treated for
hyperkalaemia and urosepsis with intravenous insulin, fluids and broad
spectrum antibiotics. Following this potassium improved to 4.9mmol/L
before increasing to 5.9mmol/L over the subsequent twentyfour hours.
Ultrasound scan of his urinary tract showed persistent bilateral
hydronephrosis, likely due to bilateral ureteric obstruction at the
point of entry into the inguinal hernia. Emergency nephrostomies were
inserted bilaterally. The patient’s clinical condition and blood tests
improved with continuing antibiotic and fluid therapy over the
subsequent three days.
At this point the management of his hernia was re-assessed and a joint
decision was made with the patient that he would have an open inguinal
hernia repair on the same admission. Following successful repair of his
hernia, nephrostogram showed no further obstruction and hence the
nephrostomies were removed. He has had no recurrence of symptoms since
his operation.